Logistics Spc. 2nd Class Robert Bannister carries a shovelful of sediment as he and his unit cleans up behind a damaged building in Hachinohe, Japan. About 17,000 U.S. military personnel are involved in relief operations in the country.

GENEVA (Reuters) - In the wake of Japan's nuclear crisis, the World Health Organization (WHO) issued fresh guidelines on how to minimize exposure to radiation that can cause cancers, especially in children and young adults.

The United Nations agency said measures taken by Japan so far meet its public health recommendations, including evacuating people within 20 km of the crippled Fukushima nuclear power plant and asking those within 30 km to stay indoors.

There was no indication of food safety risks due to imports of food products from Japan. It was also unlikely food production or harvesting in the affected area was taking place, but it said crops and livestock in the area should be protected.Following is a list of the main WHO recommendations:

* The main radionuclides released in a nuclear power plant accident are radioactive cesium and radioactive iodine. "Members of the public may be exposed directly to such radionuclides in the suspended air or if food and drink are contaminated by such materials," the WHO said.

* If radioactive iodine is breathed in or swallowed, it will concentrate in the thyroid gland and increase the risk of thyroid cancer. This risk can be lowered by taking potassium iodide pills which saturate the thyroid gland and help prevent the uptake of the radioactive material. "When given before or shortly after exposure, this step can reduce the risk of cancer in the long term," it said. National authorities are best placed to determine if it is warranted to take the tablets.

* If a dose of radiation exceeds a certain threshold level, then it can produce skin redness, hair loss, radiation burns and acute radiation syndrome. Due to their work, rescuers and nuclear power plant workers may be exposed to higher radiation doses than the general population.

* Exposure to radiation can increase the risk of cancer. Among the survivors in Japan of U.S. atomic bombs dropped in August 1945, the risk of leukemia increased a few years after radiation exposure, while the risks of other cancers increased more than 10 years after the exposure.

* The risk of thyroid cancer following radiation exposure is higher in children and young adults.

* If warranted, steps such as restricting the consumption of vegetables and dairy products produced in the vicinity of the power plant can also reduce exposure.

* "If you are coming indoors after radiation exposure, undress in the doorway to avoid further contamination in your home or shelter. Remove clothing and shoes and place them in a plastic bag. Seal the bag and place it in a safe location, away from living areas, children, and pets," it said.

* "Shower or bathe with warm, not scalding hot, water and soap. Notify authorities that you may have contaminated clothing and personal belongings to be handled appropriately and disposed of according to accepted national procedures," the WHO said.

* "If you are advised to stay indoors, you should find the safest room in your house or office building that has no windows or doors. Ventilation systems, such as heating and cooling systems, should be shut down," the agency said.

* Foods can be contaminated with radioactive materials as a result of a nuclear or radiological emergency. "The surface of foods like fruits and vegetables or animal feed can become radioactive by deposit of radioactive materials falling on it from the air or through rain water."

* Over time, radioactivity can also build up within food, as radionuclides are transferred through soil into crops or animals or into rivers, lakes and the sea where fish and shellfish could take up the radionuclides.

* "Radioactivity cannot contaminate food that is packaged; for example, tinned or plastic-wrapped food is protected from radioactivity as long as the food is sealed," the WHO said.

* In the early stages of an emergency, and if it is safe to do so, vegetables and animal fodder can be protected with plastic sheets or tarpaulins. "Bring livestock in from pasture; move animals into a shed or barn. Harvest any ripe crops and place under cover," it said.

* Avoid consumption of locally produced milk or vegetables, avoid slaughtering animals and avoid fishing, hunting or gathering mushrooms or other forest foods.

Workers at the damaged Fukushima Daiichi nuclear plant could rapidly reach their annual radiation exposure limit and may have to be rotated out soon.

An aerial view of the damaged Reactor No. 4 at the Fukushima Daiichi nuclear power facility. (Reuters)

Bursts of radiation being released at the stricken Fukushima nuclear plant could mean workers there will have to be quickly rotated out, and some could rapidly reach their annual exposure limit, complicating efforts to contain Japan's continuing nuclear crisis.

"Those are pretty brave people," David Brenner, the director of the Center for Radiological Research at Columbia University Medical Center, said of the workers. "There are going to be some martyrs among them."

Disaster officials could face a grim choice: Scale back their containment efforts or allow workers to face radiation levels that could significantly increase their risk of cancer.Reports on Thursday indicated that at times radiation was intense enough to exceed even Japan's newly raised annual limit in as little as an hour.

The new limit — 250 millisieverts — is five times the allowable exposure in U.S. nuclear plants and 125 times what workers typically receive each year.

That level of exposure raises the chances that workers will eventually die of cancer by 1 percentage point, according to John Boice, a cancer epidemiologist at Vanderbilt University and radiation safety expert.

Considering the scope of the disaster — and the fact that at least 20% of people already die of cancer — many workers may be willing to accept the danger. The situation becomes more complicated at higher doses, because radiation risk is cumulative. In other words, the risk of dying of cancer rises an extra percentage point with each additional 250 millisieverts.

It is not clear for how long the government will abide by its new limit.

There were conflicting reports about the amount of radiation the workers may have received so far. It also was not clear if the releases were planned and whether the workers were sheltered at the time.

At one point on Thursday, a level of 400 millisieverts per hour was recorded at the plant. That reading was an instantaneous measurement, and it was not clear how long that emission rate was sustained. But at that rate, a fully exposed worker would have to leave in 37 minutes, 30 seconds and not come back for a year to avoid exceeding the limit.

The Japanese government has tried to protect workers by keeping as few people on-site as possible, monitoring how much radiation they receive and limiting helicopter missions to drop water on the plant. Special clothing and respirators provide some protection from the damaging emissions.

"The main danger is gamma radiation," said Elmer Lewis, a nuclear plant safety expert at Northwestern University in Evanston, Ill. "Gamma can penetrate your body no matter what you're wearing out there. It's like a high-powered X-ray."

The plant workers are trained to react to crisis through simulated disasters, Lewis said.

But, he said, "there's really no way to anticipate what we're seeing here. They're professionals who are doing the best with what they have."

The most acute danger would come from a sudden release of radiation from which workers could not escape — an explosion, for example. That could cause radiation sickness, a devastating illness that is often fatal.

In the 1986 Chernobyl disaster in Ukraine, then part of the Soviet Union, the worst nuclear plant accident in history, workers who battled a weeklong fire were exposed to radiation at levels thousands of times higher than the Japanese yearly limit.

At first, people exposed to that much radiation might look normal. In a week, things change drastically.

"People's hair starts to fall out and the burns appear and the bone marrow damage starts," said Dr. Robert Peter Gale, a hematologist who flew to Moscow days after the accident to try to save workers airlifted there. He is scheduled to fly to Japan on Saturday to help with the Fukushima relief efforts.

Gale treated Chernobyl exposure victims with antibiotics and experimental hormones. In 13 cases, he performed bone marrow transplants in an attempt to revive their immune systems.

Of 600 workers present when the Chernobyl accident occurred, 134 developed radiation sickness, and 28 of those died within four months, according to the United Nations. Many of the rest have continued to battle health problems. Several developed cataracts.

The number of workers at the damaged Fukushima Daiichi plant during the crisis has varied from about 50 to 180, except for an hour or two when all workers had withdrawn.

Still, it is difficult to compare the accidents.

Some firefighters sent to the burning Chernobyl reactor later said they were not warned about the radiation danger, and many workers lacked protective suits and breathing devices. Soviet officials sent helicopters into the clouds of radioactive smoke to help douse the fire.

The actions of the power plant workers in Japan have already been described as heroic, and examples of heroism are common in such situations, said Dr. Fred Mettler, a University of New Mexico radiologist and advisor to the U.N. on radiation safety.

At one point during the Chernobyl disaster, he said, workers were conferring about how much water was in one reactor pool. No one knew the answer and their instruments couldn't tell them, he said. "An Armenian engineer slipped out and came back in 30 minutes. He said, 'There's 3 feet of water,' " Mettler said. "He did that on his own."

The engineer died soon after of acute radiation poisoning.

"Its always hard to tell what people are going to do," he said. "Workers have done remarkable things, some things you wouldn't expect."

Nuclear plant workers in the United States expressed a camaraderie with their Japanese counterparts, even as they puzzled over the response to the catastrophe. "I have a lot of empathy for the Japanese people, for those workers," said Charlie Arnone, 51, general manager of plant operations at the Waterford 3 facility on the Mississippi River in Killona, La. "They're clearly very dedicated folks."

Arnone, who has worked with nuclear energy since 1977, said he and other workers train according to federal Severe Accident Mitigation Guidelines, scenarios specific to each plant. They review what could happen if, for instance, they can't maintain the water level in a spent fuel pool.

"We might hook up things, basically fire nozzles that automatically spray. Then if that doesn't work, you can open up and try air cooling," Arnone said. "We just have different guidelines and tools. My understanding is the Japanese don't have that. We have all this equipment staged. We have a generator already set up, and we can pull water out of the river if we have to, to keep the core cool, the spent fuel cool."

Experts are focusing their concern on nuclear workers because the general population's exposure to radiation around the Fukushima Daiichi plant has so far been minimal.

The government quickly evacuated a 12-mile zone around the plant. Readings of radiation outside that area have remained low.

The utility that operates the plant, Tokyo Electric Power Co., has released gases laden with radioactive substances in small bursts to prevent the buildup of pressure inside the containment buildings. For now, the winds have cooperated in blowing much of the material out to the Pacific Ocean, where scientists say it settles in the water and is diluted into concentrations that pose little danger.

Even in Chernobyl, nobody in the general population suffered radiation sickness. The U.N. says that 6,500 cases of thyroid cancer can be attributed to the disaster, but because the cases were closely monitored and treated, only a few were fatal.

Those occurred mainly because people were not warned to stop drinking milk — the main way that dangerous quantities of radioactive iodine enter the body. The isotopes land on the grass, which is then eaten by cows, turning their milk radioactive.

"All they had to say was 'don't drink the milk,' " Boice said.

"In Japan, radioactive iodines are not going to be that big a deal," he said. "They won't let the milk into the food supply."

Menthol seems fresh, cool, natural -- and that's what makes it dangerous. Added to the tobacco in cigarettes, menthol makes the biologically nightmarish act of inhaling smoke feel much better than it should.

There's also data showing menthol cigarette use is common among women, minorities, the unemployed, poor people and, most alarming, adolescents. Young people, it seems, like menthol quite a bit. And who can blame them? New smokers need all the help they can get.

The report asks: "Does the availability of menthol cigarettes increase the prevalence of smoking in the population, beyond the anticipated prevalence if such cigarettes were not available? In subgroups within the population?"

And the report answers: "The evidence is sufficient to conclude that it is more likely than not that the availability of menthol cigarettes increases the likelihood of experimentation and regular smoking beyond the anticipated prevalence if such cigarettes were not available, in the general population and particularly in African Americans."

Thus does the Tobacco Products Scientific Advisory Committee make its way toward its recommendation to the FDA: "Removal of menthol cigarettes from the marketplace would benefit public health in the United States."

All that worrying might cause more harm than the radiation from the Japan nuclear accident, experts say. A look at some common concerns.

In Japan, a baby is checked for radiation exposure before entering an evacuation center in Fukushima. Meanwhile, Californians are worrying that radiation plumes will find their way to American shores. (AP Photo / Kyodo News)

With reports that a radiation plume from the Fukushima Daiichi nuclear plant could reach Southern California as soon as Friday, worried citizens have been hoarding potassium iodide pills, wondering if it's OK to go outside and otherwise fretting over an invisible, and somewhat unpredictable, threat.

But all that worrying might cause more harm than the radiation itself, experts say. Here are some answers to common concerns.

How much radiation do scientists think will arrive here?No one knows yet — but probably not a whole lot. It's unclear what's happening at the Japanese power plant, and whatever radiation escapes has to travel thousands of miles to reach U.S. shores. Over that distance, it will be greatly diluted, if it gets here at all.

Photos: In Japan, life amid crisis

In fact, the winds have been shifting, often blowing westward, back toward Japan, rather than toward the U.S., California officials said in a news conference Thursday. "We are not in Japan," said Dr. Jonathan Fielding, director of Public Health for Los Angeles County. "We are not within 10 miles of the reactor. We are 5,000 miles away — and we know a lot about dispersal patterns over that distance."

How much risk will any radiation that reaches here pose?

Not much. Gregory Jaczko, chairman of the Nuclear Regulatory Commission, an independent agency that regulates U.S. commercial nuclear power plants, told reporters Thursday that the basic science involved suggested that "there can't be any risk or harm to anyone here in the United States, or Hawaii, or any of the other [U.S.] territories."

Dr. Kei Iwamoto, of the faculty of the Division of Molecular and Cellular Oncology at UCLA, told The Times that he believed the amount of radiation from Japan that a person in California might be exposed to will be very low — perhaps around one microsievert.

To put that in perspective, people get some amount of radiation every day. Humans are exposed, on average, to 3,000 microsieverts of natural background radiation per year, according to the Centers for Disease Control and Prevention. One dental X-ray would add 40-150 µSv to that baseline. A CT scan of the abdomen, according to the Food and Drug Administration, would tack on another 8,000 µSv — more than 2 1/2 years of background radiation.

Did radiation reach here from Chernobyl? What happened then?

Yes, a tiny amount did reach the United States. But its health effects were miniscule, if they existed. "The radiation from the 1986 accident was negligible from a health standpoint. I know of no evidence that that accident caused any increase in cancer in this country," Iwamoto said.

What about kids? I've heard they're more sensitive to radiation.

That is true. "Kids are more vulnerable to radiation for a couple of reasons," said Dr. William Hendee, a radiation physicist with the Medical College of Wisconsin. "Their organs and tissues are growing and developing. Growing and developing cells are more susceptible to radiation. Kids also have a longer lifespan."

So should I keep them away from school?

No. Radiation levels are not likely to get very high. There is no reason to keep your kids out of school.

Should I take iodine tablets or eat iodized salt? It can't hurt, can it?

Well, yes, it can hurt. The tablets can be risky for some people — especially pregnant women. There is no reason to take iodine tablets at this point, said California officials at the news conference.

Indeed, potassium iodide is not recommended at all until radiation levels hit the tens of thousands of microsieverts. Levels won't reach anywhere approaching that level here.

In cases of true radiation exposure — for example, for people living close to the reactors in Japan — the benefits of potassium iodide outweigh the risks. The tablets can protect the thyroid from exposure to radioactive iodine-131 by "filling up" the gland and preventing it from taking up the radioactive iodine.

But potassium iodide can be harmful to people who are allergic to the substance or who have the skin disorders dermatitis herpetiformis or urticaria vasculitis, according to the Centers for Disease Control and Prevention. Pregnant women and infants should not be given potassium iodide because it could cause a serious thyroid disorder in infants. The supplements can cause some side effects including nausea, rashes and inflammation of the salivary glands.

As for eating iodized table salt to ward off the effects of radiation, that might work, but you'd have to gobble a great deal of the stuff — 3 1/2 pounds a day, according to the Salt Institute, an industry group — to reach the 130 milligrams of iodine you'd need. Even the institute said, in a statement, that this was not a good primary defense against radioactive fallout. That's saying something. Don't do it.

Would wearing a mask help me?

Sure, if it gives you peace of mind. "Masks would reduce a bit of the inhalation, but the amount of radioactive fallout is going to be so tiny," Hendee said. "For someone who is concerned or worried, if they felt better wearing a mask, they should wear a mask. I don't think it will reduce their risk, because the risk is already so low."

Although national health authorities defer to state governments, they will issue recommendations based on the severity of radiation levels, said Robert Taylor, a spokesman for the Nuclear Regulatory Commission. Possible recommendations include evacuating areas within 10 miles of a nuclear power plant, warning people to take shelter and close all doors and windows, and advising residents to consume potassium iodide tablets. "There's no need for U.S. citizens to take any protective measures at this time," he added.

What can I do to be safer?

Until more is known about the threat radiation from the nuclear plant might pose in California and beyond, your best bet is to get yourself prepared — for any expected emergency. Assemble your earthquake kit. Install gas shut-off valves, if your house doesn't already have them, "rather than going out and buying potassium iodide, I would encourage everyone to go out and buy three to five days of food and water, so that when we have our earthquake, you can be self-sufficient," said Howard Backer, interim director of the California Department of Public Health, at the news conference.

Most of all, address the health threats that you can control. According to the federal government, almost 1.5 million Americans die each year of heart disease or tobacco-related diseases. The best bang for your buck might be throwing away the cigarettes, exercising and improving your diet.

Let's Move! Can it make a dent in the childhood obesity problem? Hãyvận động!Có thểnócải thiệnvấn đềbéo phìở trẻ em?

Michelle Obama's public awareness program aims to improve the health of the nation's children, and maybe even their parents' health. Experts weigh in on its chances and the hurdles it must overcome.Can childhood obesity be eliminated in a generation? Will we ever get our children away from video games and into the park? Is there anything to be done about neighborhoods with a plethora of fast-food outlets and a dearth of options for eating healthfully?

A year ago, First Lady Michelle Obama launched the Let's Move! campaign from the front lawn of the White House.

She outlined her plan to focus on four primary objectives: educating and empowering parents, providing more-healthful foods in schools, increasing access to healthful foods in underserved neighborhoods and encouraging more physical activity.

Among the specifics, Obama set the goal of doubling participation in the HealthierUS School Challenge, which recognizes schools in the National School Lunch Program that have worked to promote more-healthful school environments. She also announced her intention of working with food retailers to stock more-healthful fare, and challenged kids and adults to exercise five days a week.

Many childhood obesity and nutrition experts believe that the first lady's initiative is an important step in raising national awareness about childhood obesity, which in 2008 reached an all-time high of 17% among kids age 2 through 19, according to the federal Centers for Disease Control and Prevention.

"Let's Move! is first time food issues have had this kind of legitimacy at this high a government level," said Marion Nestle, nutrition professor at New York University and the author of the book "Food Politics." "Just doing that is an enormous, enormous contribution."

But in a culture where junk food abounds and outdoor play continues to lose ground to controllers and computers, some experts are skeptical as to how successful the public awareness program — which also works to allocate funding for government agencies involved in nutrition and health, such as the Department of Health and Human Services — can be.

We spoke to five specialists in the fields of nutrition and childhood obesity to get their take on each aspect of the Let's Move! campaign:

Empowering parents

In addition to purchasing food for the family, parents and caregivers serve as role models for healthy behavior. For that reason, said Dr. William Roberts, the president of the American College of Sports Medicine, reaching adults with information about good health practices, and encouraging them to examine their own habits, is a key part of battling childhood obesity.

"The apple doesn't fall far from the tree," said Roberts, who has a private practice in Minnesota. "I can often see who will have trouble with obesity and who won't from looking at the parents; obese parents have obese kids, and active parents have active kids."

According to a report by a task force implemented by President Obama to oversee Let's Move!, the campaign has worked with a handful of government agencies to help parents make more informed decisions. The Food and Drug Administration has begun to explore the effects of putting nutrition labels on the front of food packaging, and how it can be effectively implemented. The Department of Agriculture will soon release a new food pyramid, condensing its dietary guidelines. And Michelle Obama herself has urged restaurants across the country to provide nutritional information about their dishes.

Although the program is a good start, said James Hill, the director of the Colorado Nutrition Obesity Research Center, getting parents to change their behavior is likely to be much more challenging than putting numbers on menus and packaging.

"We're talking about changing what people eat, their physical activity levels," he said. "This has been very, very difficult to do and quite frankly, we have more failure than success."

A program like Let's Move! can help, he said, but "at the end of the day, it's a cultural shift, the way smoking is now unacceptable, not wearing seatbelts is now unacceptable. It's an amazing challenge and it's going to be a lot for any one program to do alone."

Getting healthful foods in schools

In December, President Obama signed the Healthy, Hunger-Free Kids Act of 2010, which provides funding for federal school meals and child nutrition programs and is reauthorized every five years. Informed, in part, by the Let's Move! objectives, the bill requires national standards to be set for food sold at schools, including meals and vending machine snacks.

Margo Wootan, director of nutrition policy at the Center for Science in the Public Interest, worked on the bill, and said that it's passage was a victory for Let's Move! program.

Getting junk food out of schools is "something we've wanted to do for decades," she said.

To ensure compliance with the bill, one school per district nationwide will be audited every three years, said Wootan.

"The review that they do is so comprehensive and labor intensive [that] it's hard for them to do many more schools," she said, adding that she'd like to see the review process more streamlined.

Some experts, however, see the bill as falling short of what kids need.

"I think we need universal school meals," said Nestle, referring to lunches provided to all children regardless of income, "and anything short of that is an enormous compromise."

Improving access to healthful and affordable food

Areas that are dominated by fast-food restaurants and have a dearth of healthful options are another target of the Let's Move! campaign.

The program made a significant stride in January, when Wal-Mart agreed to join Let's Move! by stocking its shelves with more-healthful more-clearly labeled products. The collaboration, said Nestle, represents an important step towards getting buy-in from the food industry, which has often viewed junk food as more profitable than more nutritious fare.

"Anything Wal-Mart does is going to have an enormous effect on other food companies, because they are going to have to follow suit," she said.

Still, said Hill, the effort within the food industry is "not as coordinated as we might like it to be." And it remains to be seen whether more-healthful options will lead to more-healthful choices.

"The question is, are people just waiting for healthy food, and once you bring it in they will eat it?" he said. "I suspect that's not the case. Getting people to make these healthy choices and sustain them over time is very much a challenge."

Increasing physical activity

Without an increase in physical activity, overweight kids are likely to remain that way. To that end, Let's Move! has teamed up with national sports organizations, including the National Football League and Major League Baseball, to develop public service announcements to motivate kids who may see professional athletes as role models.

But many believe that increasing physical activity represents the biggest challenge facing the program.

"I think it's going to be easier to solve the food problem then the physical activity problem," said Hill.

Roberts suggests that schools need to support gym and recess and that city planners should keep in mind the development of play areas when "building towns and living spaces." Ultimately, though, there's no proven way to entice the unmotivated to get off the couch, he said.

"I don't know how you can get people to exercise who aren't willing to or don't want to," Roberts said. "In the end, it has to be an individual decision that you're going to make the changes you need."

Looking ahead

As the Let's Move! campaign enters its second year, it's not without political detractors. Some have criticized the first lady and the program for what they suggest is an overstepping of government bounds.

On his radio program earlier this year, talk show host Rush Limbaugh said that Obama was "urging, demanding, advocating, requiring what everybody can and can't eat."

But health experts continue to suggest that Let's Move! is on the right track, if perhaps not far-reaching enough.

"The obesity epidemic is caused by a toxic environment," said David Ludwig, who developed the Optimal Weight for Life program at Children's Hospital Boston. To truly combat it, he says, government involvement needs to include providing subsidies for farms that grow nutritious foods, as well as better funding for schools so that food quality and physical education aren't sacrificed.

Wootan adds that marketing that targets children, such as television commercials and kid-themed packaging, also needs to be curtailed.

Hill believes that until more research is done to find creative solutions to the childhood obesity epidemic, the problem may not be going anywhere.

Russia's political landscape has been relatively calm and consolidated for the past decade under former President and current Russian Prime Minister Vladimir Putin. However, recent months have seen instability rise sharply, with a purge in the government, a shift in parliamentary election results and large protests in the streets. None of these is new to Russia, but these and other factors are converging and creating changes in Russia's political landscape.

HANOI - April 19, 2009 - Vietnam's most popular TV channel, VTV3, broadcast a daylong show on Sunday, shot from five different locations around the country, to raise funds for Trai Tim Cho Em/Operation Healthy Heart. The campaign is a partnership between Vietnam Television (VTV), the East Meets West Foundation (EMW) and Vietnam Military Telecommunications (Viettel), formed to raise funds to provide poor Vietnamese children suffering from congenital heart defects with access to lifesaving surgeries.

The event, organized by the three partners, was entitled "A Day for Children’s Hearts," and included a series of live reports broadcast from four hospitals in Hanoi, Hue and Ho Chi Minh City, where five different heart surgeries were being performed.

The TV show also featured an evening show broadcast from three main stages in Hanoi, Can Tho and Ho Chi Minh City, where viewers watched interactive sessions with members of the audience as well as enjoying live performances. Audience members at the show included the Minister of Health, the Vice Minister of Health, Directors of Vietnam's National Hospitals, representatives from the three partnering organizations and Vietnamese corporate donors, as well as physicians and social organizations.

The live broadcast was the second event that has been organized for the Trai Tim Cho Em/Operation Healthy Heart campaign, which has a target fundraising goal of $1.5 million. The funds raised from Trai Tim Cho Em/Operation Healthy Heart will support the program's goals to increase the number of livesaving surgeries for poor children each year and expand the level of pediatric cardiology in Vietnam.

Grant Summary

Project:

Programmes:

Grantee:

Regions Served:

Amount Awarded:

R 480,000

Year Awarded

2007

Duration:

24 months

Brick-by-Brick – Investing in Capital Projects for Social Change

20 December 2010

The business of making social change often has to start from the ground up. Sometimes literally! Since its inception, The Atlantic Philanthropies has invested over $1.5 billion in a number of capital projects to build the infrastructure that enables health to be advanced, children and older people to achieve their full potential, and human rights leaders to gather and work more closely together.

Any major infrastructure development is always about more than the building. It also requires investment in the capacity of the people who will work in it, and close attention to the kind of sustainability that only comes with engaging the government and other stakeholders to believe in and support the effort.

In Viet Nam, our Population Health Programme has developed health infrastructure, like hospitals and clinics, and then strengthened the capacity within those institutions to deliver the best care. The Cardiovascular Centre at Hue Central Hospital is located in central Viet Nam, a particularly poor section of the country, and serves more than 20 million people. In 2003, the hospital was not equipped to perform heart surgery, and anyone requiring it would have to travel great distances to Ha Noi or Ho Chi Minh City. Beginning that year, Atlantic provided support – totalling $12 million – to construct a cardiovascular centre, equip it and train the personnel. The Cardiovascular Centre is now operating at full capacity. It has served more than 57,000 outpatients and over 24,000 inpatients, and performed more than 6,000 open heart surgeries. Perhaps most remarkably, the centre was approved to perform the first heart transplant in Viet Nam, over the other large hospitals in major cities like Ha Noi. Recently, the Ministry of Health recognised Hue Central Hospital as one of the top three hospitals in the country.

Hue Central Hospital Cardiovascular Center Supplementary Construction

Grant Summary

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Programmes:

Grantee:

Regions Served:

Opthalmology centre to open in Hue

VietNam News Agency

14 August 2008

Original Source THUA THIEN-HUE - The Health Ministry and the provincial authority of Thua Thien-Hue yesterday broke ground for the Hue Ophthalmology and Training Centre, a US$4 million addition to Hue Central Hospital. The centre is expected to significantly upgrade services to patients with severe eye illnesses. Funded by the Bermuda-headquartered NGO Atlantic Philanthropies and carried out by the East Meets West Foundation (EMW), the project is a humanitarian gift to the people of Hue and is expected to be completed by the end of 2009. The eye hospital addresses a critical need as blindness is widespread in Viet Nam, and several hundred thousand cases require surgery. Speaking at the ground-breaking ceremony, the director of Hue Central Hospital, Bui Duc Phu, said the four-storey building would include facilities equipped with state-of-the-art ophthalmology equipment for exams, diagnosis and operations as well as conference rooms and laboratories for training purposes. Hue Central is a teaching hospital and the ophthalmology department will train specialists who are capable of performing surgery to eradicate over 80 per cent of blindness in Viet Nam. Phu said EMW and AP had funded a project to build new facilities for the Hue Hospital's Pediatrics Department which were brought into operation in 2003. Four years later, with funding from the same source, the $8.3 million Hue Cardiovascular Centre became operational at Hue Central Hospital, with 200 in-patient beds, four operating theaters and an intensive care unit. This year, 1,000 surgeries are expected to be performed at the centre. "East Meets West is working towards the goal of improving overall health care in Viet Nam while targeting specific sectors, and vision is clearly one of the most essential components to a person's life," said Mark Conroy, EMW country director. EMW also built the Hue University Learning Resource Centre, a modern library that has multimedia, seminar and study areas. The partnership between Atlantic Philanthropies and EMW has provided health and higher education infrastructure in several Vietnamese cities including Ha Noi and in Thai Nguyen and Quang Tri provinces since 1998 - VNS

Viet Nam Journal: Over 11 Years, Atlantic Grants Help Spur a Country’s Transformation in Health

21 January 2010

Several of the staff of the Hue Central Hospital were kind enough to come to work last Sunday morning to give my Atlantic colleagues and me a tour of what has become a world-class facility in the ten years since our Founding Chairman, Chuck Feeney, first paid a visit. The hospital’s director, Dr. Bui Duc Phu, recalled that initial meeting for us, obviously relishing the memory of a remarkable exchange. It started with Chuck inquiring: “What do you want to do next?” Dr. Phu replied that he wanted to replace the hospital’s paediatric wing. Chuck asked, “How much do you need?” and went on to say, “How quickly can you get it done?” That, as Humphrey Bogart says to Claude Rains in Casablanca, was the beginning of a beautiful friendship, mirrored in many of the nation’s other leading medical and educational institutions.

I returned yesterday from a week in Viet Nam visiting Atlantic-supported institutions and organisations in Ha Noi, Hue, Da Nang and Ho Chi Minh City. Since Chuck Feeney’s first trip, inspired by an article he read while waiting in an airport about the work of East Meets West Foundation, now a key partner in our Viet Nam efforts, Atlantic has spent over $300 million in Viet Nam – ranging from $20-45 million a year – on a variety of construction and other projects in higher education and medical care.

Here are a few highlights from my week in Viet Nam, drawn from a daily journal I kept. I hope they convey a flavor of the challenges the country faces, the energy and effectiveness with which Atlantic’s grantees are working to meet them, and the enormous leverage they have achieved with our support.

January 14, Ha Noi The National Pediatric Hospital, virtually destroyed by bombing during what the Vietnamese call the “American War,” is at three times its capacity at the time of Atlantic’s first grant in 2003. Its director, Dr. Nguyen Thanh Liem, proudly rattled off a list of the institution’s firsts, including conjoined twin separation, open heart surgery, bone marrow transplant, kidney and liver transplant and endoscopic surgery. Sitting in on the meeting was Colin Partridge, a physician from UCSF-Mission Bay in San Francisco, another Atlantic-supported institution, a partnership made by Chuck Feeney’s desire to forge stronger links among key medical facilities in Viet Nam, California and Australia.

Along the way to the Atlantic office for lunch with staff, we marvel at the remarkable sight of thousands ofmotorbike riders wearing helmets, the culmination of a key Atlantic campaign that has resulted in dramatic reductions in traffic injuries. We even saw a helmetless rider get pulled over for a ticket. The longtime Atlantic country representative for Viet Nam, Dr. Le Nhan Phuong, also heads our global Population Health Programme. Forced to flee the country at ten in 1975, in the closing days of the war, Dr. Phuong and his sister spent a year in foster care in Oregon before being reunited with the rest of their family. Raised in Georgia and trained as a paediatrician, he returned to Viet Nam in 1999. The two other terrific programme executives in Viet Nam, who accompanied my Belfast-based colleague Martin O’Brien and me on our travels, Nguyen Trong Hau and Duong Hoang Quyen, are also physicians.

On to the Ha Noi School of Public Health. The school is at the cutting edge of the country’s preventive efforts; it is beginning to focus on the needs of the growing ageing population – only government jobs in Viet Nam carry pensions, and those are modest – and on mental health challenges like suicide, and on child injuries through drownings and other preventable accidents. There is no social work profession in Viet Nam, and addressing these issues and drug and alcohol dependency will require one, something Atlantic is working with the school’s faculty and government ministries to build.

Also housed in the school is another grantee launched with Atlantic support, the Viet Nam Public Health Association, which has played a key research and advocacy role pressing for smoke-free policies. A national campaign to discourage tobacco use, a key Atlantic priority in the country, was underway with street-wide banners everywhere in Ha Noi and also promoting implementation of stronger social welfare measures for older adults and steps to reduce the risk of exposure to dioxins that are the grim legacy of U.S. saturation of the country with Agent Orange during the war.

For dinner that evening we joined Charles Bailey from the Ford Foundation, with which we have a collaborative relationship to address the problems of environmental dioxin contamination in Viet Nam, and Professor Nguyen Tran Hien, the Director of the National Institute of Hygiene and Epidemiology, where Atlantic and Irish Aid are co-funding the establishment of the Ireland-Viet Nam Blood-Borne Virus Initiative. The initiative will include building a top-level national diagnostic facility for blood-borne viruses and developing a cadre of experts in diagnostic virology and epidemiology in Viet Nam.

Friday, January 15I spent much of the day at a roundtable of Atlantic grantees, government representatives, and diplomats and aid officials from Ireland, Australia and the U.S. in a followup discussion to a groundbreaking conference supported by Atlantic last October on the link between public health and human rights standards. I was struck by the candor of the state officials who participated in acknowledging the dimensions of the country’s health problems and seeing them in human rights terms, exacerbated by growing inequity that has accompanied Viet Nam’s remarkable economic growth over the last decade. At the same time, in a country which has far to go in acceptance of dissent and free expression, a number of our grantees spoke freely and critically about the shortcomings of government policies toward people using drugs and sex workers, and on the need for more civil society voices to be heard in health campaigns and debates.

Overall, the roundtable reinforced for me the soundness of recent developments in Atlantic’s strategies that build on our initial support for institutions to add focus on policy issues like traffic safety and smoking prevention, investing in the steady strengthening of non-governmental organisations and other vehicles for a more prominent public voice, particularly by communities most affected.

Saturday, January 16, Hue and A Luoi Having flown to Hue the night before, we spent the morning visiting with provincial health officials there and accompanying them after lunch to a rural commune health center in the A Luoi district, a two-hour drive over the mountains, not far from the Laotian border. Over seventy per cent of the commune’s residents are members of the minority Pako tribe, and as with indigenous people and minorities everywhere, they have not had equitable access to health services, so this is an increasing emphasis in Atlantic’s funding. Ten such communes in the A Luoi district are being upgraded with Atlantic funds. The commune’s midwife talked with us about her work and showed us around the small facility – there has been a steady decline in maternal and infant mortality – and during a visit to a nearby community center we dropped in on a childbirth education class taught by a village health worker using poetry and song along with more traditional methods. Most impressive is the emphasis placed on training and supporting community residents to provide for their own health needs.

Atlantic has provided support to Marie Stopes International, along with Save The Children and the Vietnam Veterans of America Foundation, to set up community-based and client-centered innovative service delivery models like this one in five provinces to complement the physical facility improvements that Atlantic has funded. Each province is then responsible for bringing those models to scale. By working with local governments, international and local NGOs, and the donor community in these efforts, we are able to address primary healthcare in a holistic, comprehensive and sustainable way.

Sunday, January 17, HueAt the Hue Central Hospital, we learn more about how our partnership with East Meets West Foundation works. The Cardiovascular Centre at the hospital has become the leading centre for heart care in Viet Nam and has been selected by the Government to perform the first heart transplant in Viet Nam later this year. Other Atlantic-supported constructions at the hospital include the Pediatric Department, the Ophthalmology Department and the Training Centre. Virtually all of the construction projects Atlantic has supported in Viet Nam have been directed through EMW, enabling buildings to come in at costs substantially lower than those sponsored by other donors. Economies of scale, avoidance of corrupt practices, and use of local materials and workers make Atlantic’s dollars go much further.

Monday, January 18, Da Nang In Da Nang, we visit the General Hospital, its new wing painted an Irish green as a gesture of respect for Chuck Feeney, who famously opposes having his or Atlantic’s name on buildings we help to construct. Patients no longer have to fly to Ha Noi or Ho Chi Minh City for challenging oncology treatment, and for a few minutes we watch open-heart surgery on a 15-year old girl, an operation that would have been unthinkable in Hue and Da Nang just a few years ago. No one should have to travel great distances for lifesaving intervention. And yet the absence in most of Viet Nam’s hospitals, even the best ones, of facilities for patients’ families to stay while they are receiving care is starkly evident in the straw mats and neatly-folded belongings we see under many stairwells in the hospital.

On from there to the Da Nang Eye Hospital, whose director, Dr. Pham Binh, is eager for me to come back for the official opening of the new facility – its entrance guarded by marble lions sculpted by a grateful patient after his eyesight was restored – in March to coincide with the 35th anniversary of the end of the war in Da Nang. In addition to surgery and treatment at the hospital, where 60 per cent of the patients are from outside the city, the hospital operates a community eye programme and provides free eyeglasses for students.

Tuesday, January 19, Ho Chi Minh CityToday we get a look, accompanied by staff of an non-governmental group, Family Health International, at the way Viet Nam is handling the treatment of drug users, an area at the intersection of health and human rights. We spend the morning at the Binh Thanh District Health Center, a community-based facility working with an integrated approach on drug addiction through counseling and methadone treatment (methadone was only legalised in Viet Nam in 2008, part of the liberalisation of the country’s punitive approach to drugs). As everywhere, there is a strong link between substance abuse and poverty – 60 per cent of those who visit the facility are unemployed, and they also get vocational and family counseling. The center also deals with men who have sex with men (we drop in on a peer training workshop attended by gay men and transgendered people), HIV/AIDS, and tuberculosis.

We then drive to the outskirts of the city for a rare visit to Nhi Xuan, one of the country’s drug rehabilitation centers for treatment of drug addicts. (About half of the clients of the Binh Thanh Center that we just visited have just been released from such a facility.) The center’s staff is earnest and eager to discuss their work – they have been heavily influenced by the U.S. Daytop Village programme, which has helped to train them – and the few dozen of the 500-plus residents we meet, all idle in their dorms after lunch due to an unseasonal rain, seem bright and friendly, but no one is there voluntarily, having been committed by their families or through the criminal justice system, and we later learn the center has a very high relapse rate. This is an emerging area in which Atlantic and Viet Nam have much work to do.

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The story of Atlantic’s work in Viet Nam over the years is one of steady support for the transformation of a poor country, battered by decades of colonialism and war, into one which is working hard, with ever-increasing capacity and sophistication, to meet the health needs of its burgeoning population, particularly in remote rural areas where the fifty-three ethnic minorities are concentrated. But it also holds larger lessons about the importance of leverage – of consistent and growing emphasis on using our funds to draw in ever-larger commitments from governments and other donors, even more crucially important since Atlantic is in its last decade of life.

Here the numbers tell the story: approximately $10 million in Atlantic support for the National Pediatric Hospital in Ha Noi has yielded $3 million in equipment from the Japanese Government and a $40 million commitment from the Vietnamese government toward the full redevelopment of the hospital; $12 million to the School of Public Health produced an equivalent donation from other sources for construction, training and equipment; the Hue Central Hospital has turned $20 million of Atlantic investment over ten years into over $50 million from other donors; the Da Nang General Hospital has pivoted $11 million in construction support into over $20 million for equipment; the Da Nang Eye Hospital also raised additional equipment and training support from other donors. The list goes on. Atlantic’s investment in the upgrading of rural health communes like the one at A Luoi district comes in the form of a grant to provincial health departments that is matched on a one-to-one basis, and on the evidence of this success, the Vietnamese government is now prepared to commit $400 million for the next three years to scale up this model nationally.

There is much work to be done in Viet Nam, but I came away with a renewed optimism that those who are striving to transform the country’s health system are using our resources to great impact and will be well placed to thrive when the turn of the next decade arrives and Atlantic has completed its work.

Key Media Partnership

In Operation Healthy Heart's most recent campaign--"Trai Tim Cho Em"--East Meets West is partnering with Vietnam Television (VTV) and Vietnam Military Telecommunications (Viettel), to raise funds to increase the number of livesaving surgeries for poor children each year and expand the level of pediatric cardiology in Vietnam. Read more about this powerful campaign.

Organizations

OHH collaborates with Vietnamese government and other nongovernmental agencies, as well as with international organizations.

Sponsoring Associations for Poor Patients (SAPP)

Assembly of God of the Protestant Church of Australia

Children of Vietnam

Children's Hospital of Oakland

Committee for Population, Families and Children in North, Central and Southern Vietnam

The Hue Central Hospital serves more than 20 million people in central Viet Nam, a particularly poor section of the country. In 2003, the hospital was not equipped to perform heart surgery, and anyone requiring such surgery had to travel to Ha Noi or Ho Chi Minh City.

That year, Atlantic provided $12 million to support construction of a cardiovascular centre, equip it and train the personnel.

Cardiovascular Centre at Hue Central Hospital, Viet Nam

Since 2004, Atlantic has provided about $12 million in support to Hue Central Hospital to construct a cardiovascular centre, equip it and train the personnel.

Cardiovascular Centre at Hue Central Hospital, Viet Nam

The Cardiovascular Centre helped Hue Central Hospital merit recognition by the Ministry of Health as one of the three top-tier hospitals in the country.

Cardiovascular Centre at Hue Central Hospital, Viet Nam

Since opening in 2007, the Cardiovascular Centre has served more than 57,000 outpatients and over 24,000 inpatients, and has performed more than 6,000 cases of open heart surgeries.

Cardiovascular Centre at Hue Central Hospital, Viet Nam

The Cardiovascular Centre at Hue Central Hospital was approved to perform the first heart transplant in Viet Nam, over other large hospitals in major cities like Ha Noi.

Hue Central Hospital, Viet Nam

This illustration depicts the Hue Central Hospital in 2020. The hospital's strategic plan includes continued capital development of its complex, including the construction and furnishing of the Ophthalmology Department and Training Centre.